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A seven-month-old with chronic intermittent biphasic stridor

A Tsagkovits1, A Hariri1, S Bhalla1

  • 1St Mary's Hospital, London, UK.

Annals of the Royal College of Surgeons of England
|April 23, 2020
PubMed

Insights

A rare cause of chronic paediatric stridor in a 7-month-old boy was an embedded pistachio shell in the esophagus. Prompt diagnosis and removal led to an uneventful recovery, highlighting the need for broader differential diagnoses.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Pulmonology
  • Pediatric Gastroenterology

Background:

  • Paediatric stridor, a high-pitched noisy sound during breathing, necessitates urgent evaluation due to potential serious underlying pathologies.
  • Common causes include congenital conditions like laryngomalacia and acquired issues such as aerodigestive tract foreign bodies.
  • Chronic stridor presentations require thorough investigation to identify the precise etiology.

Observation:

  • A 7-month-old male infant presented with a 5-month history of chronic, intermittent, biphasic stridor.
  • Initial diagnostic microlaryngoscopy and bronchoscopy identified localized tracheomalacia.
  • Subsequent chest computed tomography (CT) revealed an unexpected esophageal foreign body.

Findings:

  • The esophageal foreign body was identified as an embedded pistachio shell.
  • Immediate rigid esophagoscopy successfully removed the foreign body.
  • The infant experienced an uncomplicated recovery post-intervention.

Implications:

  • Esophageal foreign bodies, though common in children, rarely present solely with stridor without overt digestive symptoms.
  • Otolaryngologists should consider esophageal foreign bodies in the differential diagnosis of pediatric stridor, especially with atypical presentations.
  • This case underscores the importance of comprehensive diagnostic workup for persistent pediatric stridor, even when initial findings suggest other conditions.

Keywords:
Foreign bodiesOesophagusStridorVascular malformation

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